Journal of orthopaedic trauma
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Treatment of infected long bone fractures or nonunions requires stability for bony union, yet retained implants can lead to persistent infection. Antibiotic cement intramedullary nails, in addition to external fixation, are commonly used to deliver intramedullary antibiotics in infected long bone fractures and provide temporary stability. ⋯ When these methods fail to allow access to the entire length of the canal, the Reamer Irrigator Aspirator system (Synthes, Paoli, PA) serves as an effective method for removing retained intramedullary cement. The surgical technique is described, and three cases illustrate the successful use of the Reamer Irrigator Aspirator system for removal of an antibiotic cement intramedullary nail.
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To evaluate the outcomes of displaced intracapsular femoral neck fractures treated with a cephalomedullary device. ⋯ Cephalomedullary nail fixation of displaced intracapsular femoral neck fractures demonstrated mixed results. For younger patients with midcervical fractures that were well reduced, the fixation performed well. Displaced subcapital fractures in patients older than 60 years demonstrated a 100% failure rate. As a result, we cannot advocate cephalomedullary fixation for displaced intracapsular femoral neck fractures in patients older than 60 years, although in younger patients, these implants may provide an alternative to side-plate based fixation devices.
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There are many aspects of your practice that you never think of when you first get into your new practice environment. You have spent the better part of your life training in a rigorous surgical residency and possibly fellowship. ⋯ In many ways, it is the "little things" that you never learned or never thought of that will affect your overall long-term practice success, personal happiness, and relationships the most. This article reviews aspects of practice that at first glance are merely good common sense.
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We investigated the role of negative pressure therapy (NPT) in postoperative primary wound treatment and closure. To date, extensive evidence exists demonstrating the benefit of negative pressure dressings in the treatment of open wounds; our experiment tested the hypothesis that negative pressure dressings improve healing of closed (sutured) wounds. ⋯ We have observed that primarily closed surgical wounds may benefit from treatment with NPT. The benefit of using NPTs may be most pronounced in situations in which wounds are closed under tension, involve considerable soft tissue trauma, or may be at risk of subdermal hematoma formation.
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Randomized Controlled Trial Comparative Study
Randomized, prospective comparison of plate versus intramedullary nail fixation for distal tibia shaft fractures.
Malalignment has been frequently reported after intramedullary stabilization of distal tibia fractures. Nails have also been associated with knee pain in several studies. Historically, plate fixation has resulted in increased risks of infection and nonunion. Our purposes were to compare plate and nail stabilization for distal tibia shaft fractures by assessing complications and secondary procedures. We hypothesized that nails would be associated with more malalignment and nonunion. ⋯ High primary union rates were noted after surgical treatment of distal tibia shaft fractures with both nonlocked plates and reamed intramedullary nails. Rates of infection, nonunion, and secondary procedures were similar. Open fractures had higher rates of infection, nonunion, and malunion. Intramedullary nailing was associated with more malalignment versus plating. Fibula fixation may facilitate reduction of the tibia at the time of surgery. The effect of fibula fixation on tibia healing deserves further study. Economic assessment and functional outcomes data for this population will help to enhance our treatment decision-making.